Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00516
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2011
Parcel: 2S 113AB00300
Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES FERRY RD 200
Project: Oregon State Bar Subdivision: FANNO CREEK ACRE TRACTS Lot: 38
Project Description: Duct heater and VAV box installation.
Contractor: HVAC INC Owner: OREGON STATE BAR, THE
5188 SE INTERNATIONAL WAY 16037 SW UPPER BOONES FERRY RD
MILWAUKIE, OR 97222 TIGARD, OR 97224
•
PHONE: 503 - 462 -4822 PHONE: 503 - 620 -0222
FAX: 503 - 462 -6555
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/16/2011 $115.11
Class of Work: ALT Type of Const: Plan Review 11/16/2011 $28.78
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 11/16/2011 $13.81
Stories: Info Process /Archiving - Lg Sheet (over 11/16/2011 $2.00
11x17)
Project Valuation: $2,000.00 Info Process /Archiving - Sm Sheet (up to 11/16/2011 $3.50
11x17)
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $163.20
Hoods: Comm Incinerators: -
Woodstoves: Gas Fireplaces:
Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: duct work
Duct Work:
Fire /Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You pay obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ` 1 �
Issued By: / • - mittee Signature:
Call °. - '.4175 by 7:00 a.m. for the next available inspection late.
This permit card shall be kept in a conspicuous place on the job site until comp!: io of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
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City of Tigard r.. Received � ved ,ill j /A Permit No.: 26 ii LOS ,
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13125 SW Hall Blvd., Tigard, O' ,' 7 20 CO } Re iew �,p
Phone 503.639.417 1 Fax: 503.69: 1Plan 960 •
N otified/Method: p e/ ev g l / N/ I i� Other Permit: fL 01 1 —cet els'
TIGARD
Inspection Line: 503.639.4175 O`I 1 7-'1\\ Ready >»ss: 121 See I
Internet: www.tigard- or.gov N V P 2nr
mo ilk �® S upp l emental Information
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TYPE OF RK4 G 1,V3 m COMMERCIAL FEE* SCHEDULE - `USE '
PI- Mechanical permit fees' are based on the value of the work
❑ New construction (Addition/alt ration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS, FEES* ,
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: ` _(-� '" �"v �/ �/ � �'' ��tt ,/41 - Air conditioning heat pump
/ V � �� 6 J �Q n tl V VC. C/ti" ` e/ i (requires site plan shhoo wing placement) 14.00
City /State /ZIP: - G t ""� t; ar dl 1') -33 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: y) Project name: O. Stc C6RA/ Gas heat pump 14.00
Cross street/directions to job site: S-t- 1+✓� Q tiles 1 ib A ,ttre.. 'WI Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue/vent for any of above 6.80
Other: _ 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
g,,vV I�/1 � `- V V ;) - L1e�5- V �' /
Gas fireplace 10.00
Alt (AUV i ) �/ Flue vent for water heater or gas
j I/�
�� " �� ��� �� �� `"��p � `(- I On fireplace 10.00 Log lighter (gas) 10.00
• 1 1)16 01 Wood /pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER Chimney/liner /flue/vent 10.00
❑ TENANT Other: 10.00
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
\ A.) \ L. Fuel 10.00
Business name:
1' l �� L/ Fuel piping
Contact name: - k Furnace, " $5.40 for first four; $1.00 for each additional
Address: S 1 '$ S i� w
A�/
/Dii at )0).4.0--"P Fuace, etc.
Gas heat pump
City/State /ZIP: 'M 1 l\)p, K VC 11.2-2' /)"-- ' Wall /suspended/unit heater
Phone: ('53)\( b'v 1.4 Fax: : (so )`4 b d_A 5 Water heater
� Fireplace
i
E -mail: -) oCk di (C lAVG,,bylu '^p` Uiv / r 1
Range
e
CONTRACTOR Barbecue
Business name: 14\,) Al.., 1 .P Clothes dryer (gas)
3 Oth er:
Address: �. 3V4 MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lie.: ) • \ State surcharge (12% of permit fee)
TOTAL PERMIT FE t t ?, Yr)
Authorized signature: This permit application expires if a permit is not ob ' ed within ISO
A . ) r days after it has been accepted as complete.
Print name: ck , t ( � Q " t /t'V Date: 1, 1 \N 1 I 1 ' Fee methodology set by Tri- County Building Industry Service Board
LABuildingWermits\MEC- PermitA p.doc 01/19/07 440 - 46171' (I I /02/COM/WEB)